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The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations

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Abstract

The diversion of antiretroviral medications (ARVs) has implications for the integrity and success of HIV care, however little is known about the ARV illicit market. This paper aimed to identify the motivations for buying illicit ARVs and to describe market dynamics. Semi-structured interviews (n = 44) were conducted with substance-involved individuals living with HIV who have a history of purchasing ARVs on the street. Grounded theory was used to code and analyze interviews. Motivations for buying ARVs on the illicit market were: to repurchase ARVs after having diverted them for money or drugs; having limited access or low quality health care; to replace lost or ruined ARVs; and to buy a back-up stock of ARVs. This study identified various structural barriers to HIV treatment and ARV adherence that incentivized ARV diversion. Findings highlight the need to improve patient-provider relationships, ensure continuity of care, and integrate services to engage and retain high-needs populations.

Resumen

El desvío de los medicamentos antiretrovirales (ARVs) tiene implicaciones para la integridad y el éxito de la atención del VIH, sin embargo hay poco conocimiento sobre el mercado negro de ARVs. Este manuscrito tuvo como objetivo identificar las motivaciones para la compra de ARVs ilícitos y describir la dinámica del mercado. Las entrevistas semi-estructuradas (n = 44) se llevaron a cabo con personas que eran usadores de drogas, VIH-positivas, y con un historial de comprar ARVs en la calle. La metodología cualitativa del “Grounded theory” fue utilizada para codificar y analizar las entrevistas. Las motivaciones para la compra de ARVs en el mercado ilícito fueron: para la recompra de los ARVs después de haberlos desviado por dinero o drogas; tener acceso limitado a, o baja calidad de, servicios de salud; para reemplazar ARVs que fueron perdidos o arruinados; y para comprar una reserva de ARVs. Este estudio identificó varias barreras estructurales al cuidado de VIH y a la adherencia a los ARVs que a la misma vez incentivaron la desviación de los ARVs. Los hallazgos iluminan la necesidad de mejorar las relaciones entre la paciente y el proveedor, asegurar la continuidad del cuidado, e integrar los servicios de salud para lograr un mejor involucramiento y retención de poblaciones de altas necesidades en el cuidado del VIH.

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Acknowledgments

This research is supported by PHS Grant Number R01DA023157 from the National Institute on Drug Abuse (NIDA). NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of this report; or in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL, 33137, USA

    Kiyomi Tsuyuki, Hilary L. Surratt, Maria A. Levi-Minzi, Catherine L. O’Grady & Steven P. Kurtz

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  1. Kiyomi Tsuyuki
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  2. Hilary L. Surratt
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  3. Maria A. Levi-Minzi
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  4. Catherine L. O’Grady
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Correspondence to Kiyomi Tsuyuki.

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Tsuyuki, K., Surratt, H.L., Levi-Minzi, M.A. et al. The Demand for Antiretroviral Drugs in the Illicit Marketplace: Implications for HIV Disease Management Among Vulnerable Populations. AIDS Behav 19, 857–868 (2015). https://doi.org/10.1007/s10461-014-0856-2

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